In this paper we discuss the concepts of physical and emotional pain and people’s reactions such as pain-based behaviours. We describe our work with children and young people in the Victorian (Australia) child protection and out-of-home care system who have experienced many painful experiences often resulting in pain-based behaviours. We describe our practice approach with a description of the “PAIN Relief” emotional first aid tool. We highlight implications for practice, and training in response to emotional pain and pain-based behaviours.